Willingness to contribute for health insurance scheme and its determinants among civil servants in Addis Ababa

Abstract

Background: Ethiopia endorsed health care reforms to obtain resources, increase efficiency and promoting sustainability of health care financing. One of the components of the reform is to provide social health insurance for formal and community based health insurance for informal sectors. In the long run, the government plans to create strong risk pool and create equity in the health system by merging SHI and CBHI schemes. Objectives: To assess willingness to contribute for community-based health insurance and factors affecting it among civil servants in Addis Ababa. Methods: Institutional based Cross-sectional study was conducted in selected governmental organization in Addis Ababa. Total of 487 respondents who were selected using multi-stage sampling method were participated. The data was collected using structured self-administered questioner then entered and analyzed with SPSS version 21.0. A descriptive analysis was performed to describe the characteristics of participants. Chi-square test was used to test association between selected socio-demographic characteristics and awareness of health insurance scheme. Binary and then multiple logistic regressions were used to know the final predictors of willingness to contribute among the independent variables at P-value <0.05. Result: Among 478 respondents, 115(24.1%) of them were willing to contribute for CBHI scheme. Those who are willing contribute 240ETB (8.3$US) per annum. The finding revealed that gender, educational status, trust in health insurance agency, participation in traditional saving association and community solidarity significantly determine willingness to contribute for CBHI. The main reason for not willing to contribute for CBHI was found to be lack of enough income. From the study participants only 22.8% (109) of had good awareness about health insurance schemes. Conclusion: This study finds the share of civil servants who are willingness to support CBHI scheme is low in Addis Ababa. Building trust on the scheme and enhance social solidarity are found to be important factor to influence willingness to for the scheme. Interventions to reduce poverty and expand educational coverage are also important issues to be considered in order to make civil servant to contribute to CBHI on volunteer basis.